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Hoy — Abril 13th 2021Tus fuentes RSS

Chinesisation, adaptation and validation of the Chelsea Critical Care Physical Assessment Tool in critically ill patients: a cross-sectional observational study

Por: Zhang · Z. · Wang · G. · Wu · Y. · Guo · J. · Ding · N. · Jiang · B. · Wei · H. · Li · B. · Yue · W. · Tian · J.
Purpose

To translate and adapt the Chelsea Critical Care Physical Assessment Tool (CPAx) into Chinese version (‘CPAx-Chi’), test the reliability and validity of CPAx-Chi, and verify the cut-off point for the diagnosis of intensive care unit-acquired weakness (ICU-AW).

Study design

Cross-sectional observational study.

Methods

Forward and back translation, cross-cultural adaptation and pretesting of CPAx into CPAx-Chi were based on the Brislin model. Participants were recruited from the general ICU of five third-grade class-A hospitals in western China. Two hundred critically ill adult patients (median age: 53 years; 64% men) with duration of ICU stay ≥48 hours and Glasgow Coma Scale ≥11 were included in this study. Two researchers simultaneously and independently assessed eligible patients using the Medical Research Council Muscle Score (MRC-Score) and CPAx-Chi.

Results

The content validity index of items was 0.889. The content validity index of scale was 0.955. Taking the MRC-Score scale as standard, the criterion validity of CPAx-Chi was r=0.758 (p

Conclusions

CPAx-Chi demonstrated content validity, criterion-related validity and reliability. CPAx-Chi showed the best accuracy in assessment of patients at risk of ICU-AW with good sensitivity and specificity at a recommended cut-off of 31.

Are medical record front page data suitable for risk adjustment in hospital performance measurement? Development and validation of a risk model of in-hospital mortality after acute myocardial infarction

Por: Wu · C. · Zhang · D. · Bai · X. · Zhou · T. · Wang · Y. · Lin · Z. · He · G. · Li · X. · for the China PEACE Collaborative Group · Weng · Xie · Wu · Chen · Li · Wang · Yu · Li · Li · Hao · Zhang · Wu · Zhang · Liu · Wang · Jia · Bate · Qiqige · Jin · Cai · Liu · Xu · He · Yang · Yuan · Wang · Gu
Objectives

To develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data.

Design

A nationally representative retrospective study.

Setting

Representative hospitals in China, covering 161 hospitals in modelling cohort and 156 hospitals in validation cohort.

Participants

Representative patients admitted for acute myocardial infarction. 8370 patients in modelling cohort and 9704 patients in validation cohort.

Primary outcome measures

In-hospital mortality, which was defined explicitly as death that occurred during hospitalisation, and the hospital-level risk standardised mortality rate (RSMR).

Results

A total of 14 variables were included in the model predicting in-hospital mortality based on MRFP data, with the area under receiver operating characteristic curve of 0.78 among modelling cohort and 0.79 among validation cohort. The median of absolute difference between the hospital RSMR predicted by hierarchical generalised linear models established based on MRFP data and complete medical record data, which was built as ‘reference model’, was 0.08% (10th and 90th percentiles: –1.8% and 1.6%). In the regression model comparing the RSMR between two models, the slope and intercept of the regression equation is 0.90 and 0.007 in modelling cohort, while 0.85 and 0.010 in validation cohort, which indicated that the evaluation capability from two models were very similar.

Conclusions

The models based on MRFP data showed good discrimination and calibration capability, as well as similar risk prediction effect in comparison with the model based on complete medical record data, which proved that MRFP data could be suitable for risk adjustment in hospital performance measurement.

Different fixation pattern for thoracolumbar fracture of ankylosing spondylitis: A finite element analysis

by Tianyu Zhang, Yanhua Wang, Peixun Zhang, Feng Xue, Dianying Zhang, Baoguo Jiang

The objective of this study is to establish an ankylosing spondylitis (AS) thoracolumbar fracture finite element (FE) model and provide a proper posterior fixation choice from the biomechanical perspective. The ankylosing spondylitis T9-L5 FE model was built and the range of motion (ROM) was compared to previous studies. The L1 transverse fracture was simulated and was separately fixed by five different patterns. The pull force and yielding force of the screws, the von Mises stress of the internal fixation, and the displacement of fracture site were analyzed to evaluate the proper fixation pattern for thoracolumbar fracture of AS. ROM of AS model was obviously restricted comparing to the normal vertebral experimental data. All the fixation patterns can stabilize the fracture. At least four levels of fixation can reduce the von Mises stress of the internal fixation. Four levels fixation has a higher pull force than the six levels fixation. Skipped level fixation did not reduce the stress, pull force and yielding force. The kyphosis correction did not change the biomechanical load. At least 4 levels fixation was needed for AS thoracolumbar fracture. The cemented screws should be chosen in 4 levels fixation to increase the holding of the screws. The skipped fixation has no advantage. The kyphosis correction can be chosen after weighing the pros and cons.

Pentoxifylline for the prevention of contrast-induced nephropathy: systematic review and meta-analysis of randomised controlled trials

Por: Wei · L. · Zhang · W. · Yang · Y. · Li · D.
Objectives

To summarise current evidence on the use of pentoxifylline (PTX) to prevent contrast-induced nephropathy (CIN).

Methods

The PubMed, Embase and CENTRAL databases were searched for randomised controlled trials including patients with and without PTX undergoing contrast media exposure. We analysed the incidence of CIN and serum creatinine changes before and after contrast media exposure. All statistical analyses were conducted with Review Manager V.5.3.

Results

We finally enrolled in seven randomised controlled trials with a total of 1484 patients in this analysis. All of seven included studies were performed in patients undergoing angioplasty or stenting. The overall rates of CIN were 8.8% and 10.4% in the PTX groups and control groups, respectively. However, no significant reduction in the CIN rate was observed in the patients treated with PTX compared with the control groups (OR 0.81, 95% CI 0.57 to 1.13, I2=0, p=0.21). All studies reported no hospital mortality and the new requirement for dialysis during the trials.

Conclusion

Perioperative administration of PTX to patients undergoing angioplasty did not significantly reduce the development of CIN but showed some weak tendency of lower serum creatinine increase. Based on the available trials, the evidence does not support the administration of PTX for the prevention of CIN. More trials with larger sample sizes are needed to evaluate the role of PTX in CIN prevention.

New screening tool for neonatal nutritional risk in China: a validation study

Por: Zhou · M. · Li · Y. · Yin · H. · Zhang · X. · Hu · Y.
Objective

A neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.

Design

Prospective validation study.

Setting and participants

In total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.

Main outcome measures

We evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.

Results

The sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.

Conclusion

The validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.

Trial registration number

ChiCTR2000033743.

Relationships of organisational justice, psychological capital and professional identity with job burnout among Chinese nurses: A cross‐sectional study

Abstract

Aims and objectives

The present study was aimed at describing the status of job burnout and exploring the mediating roles of psychological capital and professional identity on the association between organisational justice and job burnout.

Background

With the shortage of nurses all over the world, nurses’ job burnout has become the focus of studies in recent years. However, limited published research has examined the mediating roles of psychological capital and professional identity on the association between organisational justice and job burnout within hospital contexts in China.

Design

A cross‐sectional design.

Methods

A total of 1,009 nurses were enrolled from a major general hospital located in Qiqihar City in the northeast of China from March–July 2018, and asked to complete questionnaires regarding organisational justice, psychological capital, professional identity and job burnout. The STROBE checklist was adhered to in this study.

Results

It was observed that the overall proportion of nurses with job burnout was 58.8%. All the correlations among organisational justice, psychological capital, professional identity and job burnout were statistically significant, with coefficients ranging between −0.487–0.863. Psychological capital and professional identity had indirect effects equal to −0.072 and −0.142, respectively, on the association between organisational justice and job burnout, taking up 13.7% and 26.9% of the total effect, respectively. The serial indirect effect of psychological capital and professional identity was −0.129, accounting for 24.5% of the total effect.

Conclusions

This study showed the necessity of addressing the status of job burnout among Chinese nurses. Psychological capital and professional identity may mediate the linkage between organisational justice and job burnout independently and accumulatively.

Relevance to clinical practice

Nursing managers should strengthen organisational justice and improve the psychological capital and professional identity of nurses through effective strategies to prevent the job burnout of nurses.

Cluster analysis of self‐concept and job satisfaction in Chinese nurses with master’s degree to identify their turnover intention: A cross‐sectional study

Abstract

Aims and objectives

This study aimed to implement cluster analysis of self‐concept and job satisfaction to identify subgroups in nurses with master's degree and explore the associations of turnover intention with characteristics among these clusters.

Design

A cross‐sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Methods

A convenience sample of 408 nurses with master's degree in China filled out the survey from 19 November 2019 to 30 December 2019. A sociodemographic questionnaire, the Nurses’ Self‐Concept Questionnaire (NSCQ), Job Satisfaction Scale (JSS) and Turnover Intention Questionnaire (TIQ) were adopted to collect the data. K‐means cluster analysis was implemented on the R software, and data were analysed using SPSS 24.0.

Results

Three subgroups were identified based on cluster analysis of NSCQ and JSS subscales in 405 nurses (99.3%) available for statistical analysis, among whom 30.9%, 17% and 48.1% were allocated to these clusters respectively. Turnover intention significantly differed among the three clusters, with cluster 2 having the highest turnover intention and cluster 1 having the lowest turnover intention. Working department, position, professional title, clinical nurse specialist and annual income were factors differentiating TIQ scores in each cluster.

Conclusions

This study identified three clusters of nurses with master's degree and showed that each cluster was associated with the level of turnover intention. The unique characteristics of the three clusters may be also helpful in identifying and providing specific managerial or social support to reduce turnover rates in nurses with master's degree.

Relevance to clinical practice

Cluster analysis is s an unsupervised machine learning method to identify meaningful subgroups within heterogeneous population based on variables distributions and patterns underlying in the data set. Through clustering, nurses with multi‐dimensional characteristics could be allocated into subgroups associated with turnover intention. As a result, nursing managers could provide approaches for each subgroup to reduce turnover intention.

Influence of transition readiness from paediatric to adult health care on quality of life in child–parent dyads with long‐term conditions

Abstract

Aim

To delineate the impact of perspective of children's transition readiness from paediatric to adult health care on quality of life in child–parent dyads with long‐term conditions. We used Actor–Partner Interdependence Model to identify actor effects (effect of one's own transition readiness on one's own quality of life) and partner effects (effect of one's own transition readiness on the partner's quality of life).

Design

A multi‐centre cross‐sectional survey.

Methods

The study was conducted in two paediatric hospitals in China from October 2018‐August 2019. We used a researcher‐designed questionnaire to collect demographic and clinical characteristics. Furthermore, we used four questionnaires assessing transition readiness and quality of life in child and parent respectively to collect data from 370 child–parent dyads. Structural equation modelling was applied to estimate the effect of actor–partner interdependence models.

Results

The total score of transition readiness had two actor effects on total child and parent quality of life controlling for age (β children = 3.335, p = .032 and β parents = 8.952, p < .001), while only one actor effect controlling for gender (β parents = 8.891, p < .001). Specific transition readiness dimensions had different partner effects on different domains of children and parents' quality of life. Moreover, younger children and fathers had a better quality of life.

Conclusion

Our study verified inherently interpersonal relationship that transition readiness appeared to influence quality of life in child–parent dyads with long‐term conditions.

Impact

This study was the first to verify mutual influence of transition readiness and quality of life in child–parent dyad using actor–partner interdependence model. Nurses who design the transition promoting programs should consider the effective communication between healthcare provider and child–parent dyads and support parents' involvement to improve shared understanding about managing child's condition, especially for older children and mothers.

Physical activity in the context of advanced breast cancer: An integrative review

Abstract

Aims

To describe and synthesize diverse empirical evidence regarding physical activity (PA) in the context of advanced breast cancer (ABC).

Design

Integrative review guided by the work of Whittemore and Knafl (2005).

Data sources

Six electronic databases were systematically searched to identify relevant literature published between January 2007–June 2019.

Review methods

Abstracts of papers that met the inclusion criteria were reviewed by two researchers and full texts of eligible papers were assessed. Data were extracted by two independent researchers and inter‐rater reliability of data extraction established. Quality of papers was evaluated using the Mixed Methods Appraisal Tool. Data were organized according to comprehensive thematic analysis and the biobehavioural model for the study of exercise interventions.

Results

Of the 532 abstracts, 18 studies met the inclusion criteria which included six randomized controlled trials, one quantitative non‐randomized study, seven quantitative descriptive studies, three mixed method studies and one qualitative study. Results from studies enrolled fell into four domains: PA performance and its influence on survival; barriers and preferences for PA; interventions to enhance PA; perceived benefits of PA from qualitative feedback.

Conclusion

Evidence suggests that ABC patients are physically inactive. Main barriers of PA are less aerobic fitness and heavy symptom burden. Simple, tailored and specialist‐supervised PA is preferred by ABC patients. Form of joint self‐instructed and group accompanying is advocated as well. PA intervention programmes identified in this review vary on type, intensity, duration and frequency, while generally, are found to be feasible, safe and beneficial to patients’ physical and psychosocial well‐being.

Impact

The results propose tailored, supervised, group‐based PA programmes are in urgent need for ABC patients. Clinical professionals should manage more feasible and safer PA interventions to help improve patients’ overall health. More research with rigorous methodology design is warranted to explore PA’s effect on long‐term health outcomes.

Assessment of compliance with oral nutritional supplementation and exploration of barriers and facilitators for patients after gastrectomy: A mixed‐methods study

Abstract

Aims

To evaluate the compliance of patients after gastrectomy in taking oral nutritional supplementation and to explore the promoting and hindering factors.

Design

A mixed‐methods design with an explanatory sequential approach was employed.

Methods

We conducted a 12‐week longitudinal study to evaluate the oral nutritional supplementation compliance of 122 patients after gastric cancer surgery and the factors that affected their compliance. After the quantitative phase, we selected the interview subjects and developed the interview outline based on the analysis of the quantitative results. In‐depth interviews (n = 15) were conducted to explain and supplement the quantitative phase results. Data were collected from October 2019 to May 2020.

Results

The average overall compliance rate of oral nutritional supplementation in patients with gastric cancer over 12 weeks was 30.59%. Adverse reactions to oral nutritional supplementation, the identity of the main caregivers and the patient's financial ability were independent factors that affected patient compliance. In subsequent interviews, we extracted four themes: social support plays an important role in patients taking oral nutritional supplementation, adverse reactions discourage patients from continuing to take oral nutritional supplementation, patients' attitudes affect their motivation to take oral nutritional supplementation, and the different needs of patients for oral nutritional supplementation affect patient compliance.

Conclusion

Patients' compliance with oral nutritional supplementation after gastric cancer surgery is very low. Health education should pay more attention to the management of adverse reactions and the role of patients' peers and family members. Oral nutritional supplementation products should be diversified to provide patients with more choices.

Impact

This study clarifies the factors that hinder and promote oral nutritional supplementation compliance and provides an important reference for the establishment and revision of health education strategies for patients after gastric cancer surgery.

Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obes

Por: Wu · Y. · Marc · I. · Bouchard · L. · Ouyang · F. · Luo · Z.-C. · Fan · J. · Dubois · L. · Masse · B. · Zhang · J. · Leung · P. C. K. · Liao · X. P. · Herba · C. M. · Booij · L. · Shen · J. · Lewin · A. · Jiang · H. · Wang · L. · Xu · J. · Wu · W. · Sun · W. · Wu · J. · Li · H. · Lei · C. · Kozyrsky
Introduction

Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk.

Methods and analysis

This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study.

Ethics and dissemination

The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l’Estrie–CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation.

Trial registration number

ChiCTR1800017773.

Protocol version

November 11, 2020 (Version #5).

Effect of weekly teriparatide injections on osteoporotic fracture healing: protocol for a double-blind, randomised controlled trial

Por: Zhu · J. · Zhang · C. · Jia · J. · Yuan · W. · Zhang · M. · Leng · H. · Song · C.
Introduction

Both animal studies and clinical trials have shown that daily parathyroid hormone administration promotes bone fracture healing. We previously found that weekly injections of the recombinant human parathyroid hormone teriparatide at a dosage of 20 μg/kg promoted tibial fracture healing to the same extent as daily injections of teriparatide at a dosage of 10 μg/kg in a rodent model. However, the effect of weekly teriparatide administration on human fracture healing is unreported. This protocol describes a randomised controlled clinical trial designed to evaluate whether weekly administration of teriparatide accelerates fracture repair in humans.

Methods and analysis

This single-centre, double-blind, randomised controlled trial will be conducted in Peking University Third Hospital. Eligible patients with Colles’ fracture incurred within 48 hours will be randomly divided into two groups (n=40 per group) that will receive 14 weekly subcutaneous injections of either saline or teriparatide (40 μg/week). The primary outcome will be the time taken to achieve radiographic healing, as assessed using the modified radiographic union scale for tibial fractures. The secondary outcomes will be functional assessments, including the self-administered Patient-Rated Wrist Evaluation questionnaire, grip strength and rate of fracture non-union.

Ethics and dissemination

Ethical approval has been obtained from the Peking University Third Hospital Medical Science Research Ethics Committee (M2020207). The findings will be disseminated in peer-reviewed publications.

Trial registration number

NCT04473989: protocol version: 1.

Ayer — Abril 12th 2021Tus fuentes RSS

Influence of incentive nursing intervention on recovery of burn patients after vacuum sealing drainage

Abstract

To observe the effect of application of incentive nursing intervention (INI) on recovery in burn patients undergoing vacuum sealing drainage (VSD). From January 2017 to January 2020, a total of 82 consecutive burn patients were prospectively enrolled, and divided into INI group and routine nursing intervention (RNI) group according to random number table method. The causes of inadequate drainage were collected, the incidence was calculated, and the occurrence of inadequate drainage at different locations was compared. The pain degree and comfort status before and after the intervention were observed, and the wound healing time, hospital stay, and satisfaction after the intervention were recorded. The reasons for inadequate drainage during the treatment of VSD included negative pressure insufficient, drainage tube blockage because of escharosis, replacement of negative pressure internal sac not standard, loose sealing of the semi‐permeable membrane, and the negative pressure tube fell off, compressed or reflexed. The baseline characteristics between the two groups were comparable (P > .05). The incidence of each cause and total incidence of inadequate drainage in INI group were lower than those in RNI group (P < .05, respectively). The incidences of inadequate drainage of all burn sites in INI group were lower than those in RNI group, and the difference of limbs wound between the two group was statistically significant (P < .05). After intervention, the pain intensity of INI group was lower than that of RNI group (P < .05), and the holistic comfort of INI group was higher than that of RNI group (P < .05). The wound healing time and hospital stay time in INI group were lower than those in RNI group, and the total satisfaction rate in INI group was higher than that in RNI group (P < .05, respectively). Applying INI can effectively reduce the incidence of insufficient drainage, reduce pain, improve comfort, shorten wound healing time and hospital stay, and thus improve the overall satisfaction rate of patients, which is worthy of clinical promotion and application.

The Z‐plasty contributes to the coalescence of a chronic non‐healing wound

Abstract

This study aimed to explore the treatment effect of Z‐plasty on a non‐healing wound. A total of 72 patients diagnosed with a chronic non‐healing wound in Peking University Third Hospital from November 2009 to August 2019 were retrospectively analysed. Among them, 27 patients were treated with Z‐plasty, and 45 patients were treated with the general method. Detailed patient information was retrieved from medical records, including age, gender, body mass index (BMI), alcohol, smoking, and comorbidities (diabetes mellitus, hypertension, heart disease). Surgical parameters included operation time and intraoperative blood loss. Wound swelling, epidermal blisters, wound edge colour, and skin temperature at 1 day after surgery were assessed to evaluate the blood supply of the wound. Surgical complications included infection, haematoma, dehiscence, and non‐healing within 2 weeks postoperatively. Student t test (for continuous data) and Chi‐square test (for categorical data) were conducted to determine the statistical difference. We found no significant differences in age, gender, BMI, alcohol, smoking, and comorbidities between the two groups. Z‐plasty did not show any advantages in the surgical time, invasive blood loss, hospital days, and hospitalisation expenses. The incidence of abnormal wound edge colour with Z‐plasty was significantly lower than that with the general treatment (P < .05), and the Z‐plasty enables better healing of the patient's wound (P < .05). Z‐plasty promoted better recovery of chronic non‐healing wounds than direct suturing.

A systematic review and meta‐analysis of perforator flaps in plantar defects: Risk analysis of complications

Abstract

The purpose of this study was to identify the risk factors for complications of perforator flaps in plantar reconstruction. A systematic review was performed by searching the PubMed, Cochrane Library, MEDLINE, and EMBASE databases from their inception date up to October 2020. Only studies on reconstructing plantar defects with perforator flaps were included, and specific data were required for each patient in the included studies. A total of 14 studies involving 111 flaps were identified and included in the meta‐analysis. Our meta‐analysis identified two risk factors for postoperative complications: flap size over 50 cm2 (risk ratio [RR] = 3.12; P = .02), diabetes mellitus foot (RR = 3.26; P = .03). No significant differences were found regarding heel defects (P = .34), single perforator (P = .57), age older than 60 years (P = .19), chronic aetiology (P = .13), trauma (P = .33), tumour resection (P = .60), ulcer (P = .84), and burn (P = .76). Although more high‐quality studies with adequate sample sizes are needed, this meta‐analysis indicated that flap size over 50 cm2 and diabetes mellitus foot were significant risk factors for postoperative complications of perforator flaps in plantar reconstruction.

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Direct-to-consumer telemedicine visits demonstrate decreased antibiotic prescribing quality in paediatric clients with acute respiratory infections

Por: Zhang · N. · Marra · L.

Commentary on: Ray, KN, Shi, Z, Gidengil, CA, et al. Antibiotic prescribing during pediatric direct-to-consumer telemedicine visits. Pediatrics 2019;144(2);doi:10.1542/peds.2019-1786B.

Implications for practice and research

  • Direct-to-consumer (DTC) telemedicine consultations among paediatric clients correlate with lower guideline-concordant antibiotic prescribing and increased antibiotics used compared with other settings for acute respiratory infection (ARI).

  • Nurses should be aware of the implications of telemedicine consultations in antibiotic prescribing quality for paediatric clients to advocate for judicious and guideline-concordant antibiotic usage.

  • Future research should examine interventions that improve antibiotic prescribing quality among paediatric clients with ARI using DTC telemedicine consultations.

  • Context

    DTC telemedicine consultations are becoming increasingly common. The literature identifies that for non-paediatric patients antibiotic prescribing quality is similar compared with face-to-face medical visits.1 Ray et al examined antibiotic prescribing patterns to treat ARI using DTC telemedicine consultations compared with PCP visits and urgent care visits...

    Disclosure experience among COVID‐19‐confirmed patients in China: A qualitative study

    Abstract

    Aim

    To understand COVID patients’ experiences of and perspectives on disclosure of their illness and to explore and describe the factors affecting disclosure decisions among COVID patients in China.

    Background

    Disease disclosure is a critical component of prevention and control of a virus outbreak, and this is especially true during the COVID‐19 pandemic. Understanding COVID patients’ experiences and perspectives on disclosure could play a vital role in COVID management.

    Design

    A qualitative study.

    Methods

    A semi‐structured interview guide was used to conduct qualitative in‐depth interviews from April to June 2020. All the interviews were audio‐recorded and transcribed, and then, a thematic analysis was conducted. The Standards for Reporting Qualitative Research (SRQR) were applied to this study.

    Results

    A total of 26 COVID‐confirmed patients were recruited for the in‐depth interviews. Four themes emerged from the thematic analysis on disclosure: persons disclosed to, reasons for disclosure, reasons for nondisclosure and impact of disclosure. The participants disclosed their COVID diagnosis to different groups, including family, close friends, community members and workplace contacts. The main reasons for disclosure included the following: government policy, social responsibility, gaining support and fear of being blamed for nondisclosure. However, some participants decided not to disclose to some groups for fear of facing stigma and discrimination or to protect family members from discrimination. Despite the potential benefits of obtaining support after disclosure, many participants did experience stigma and discrimination, privacy exposure, psychological distress and social isolation.

    Conclusions

    An individual's decision as to whether to disclose their COVID‐positive status is affected by many factors. To prevent the spread of COVID‐19 and reduce the potential risks of disclosure, such as discrimination and privacy exposure, a balanced intervention should be designed to protect COVID patients and to secure any contact tracing. Therefore, the chances of discrimination could be decreased and patients’ confidentiality could be protected.

    Relevance to Clinical Practice

    As the number of COVID patients increases, disclosure of an individual's infectious status is encouraged by health departments. Despite the potential benefits of disclosure, discrimination and privacy exposure should not be ignored. A disclosure protocol is necessary to ensure patients’ privacy regarding their COVID status.

    The levels, prevalence and related factors of compassion fatigue among oncology nurses: a systematic review and meta‐analysis

    Abstract

    Background

    Compassion fatigue is described as the phenomenon of exhaustion and dysfunction in healthcare workers resulting from prolonged exposure to work‐related stress and compassion stress. Oncology nurses are at high risk for compassion fatigue.

    Aims

    Our study aims to estimate the levels, prevalence and related factors of compassion fatigue dimension in oncology nurses.

    Design

    Systematic review and meta‐analysis.

    Method

    Ten electronic databases were conducted in the systematic review and meta‐analysis. Time frame of the searches is from inception up to 31 January 2020. The research team independently conducted study selection, quality assessments, data extractions and analysis of all included studies. The means, standard deviations and prevalence of three dimensions of compassion fatigue were pooled using random‐effects meta‐analysis. The PRISMA guideline was used to report the systematic review and meta‐analysis. PROSPERO registration number: CRD42020205521.

    Results

    The systematic review included 21 studies, involving 6533 oncology nurses across 6 different countries. In our studies, the pooled mean scores of compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS) were 35.47 (95% CI: 33.54–37.41), 24.94 (95% CI: 23.47–26.41) and 24.48 (95% CI: 23.36–25.60), respectively; the pooled prevalence of “low” rates of CS, “high” rates of BO and STS were 20% (CI 13%–28%), 22% (CI 18%–26%) and 22% (CI 17%–28%), respectively; furthermore, geographical regions (Asia) significantly affect the prevalence of compassion fatigue among oncology nurses. The compassion fatigue variables considered were demographic (age, marital status, education background, health condition and gender), work‐related (job satisfaction, income satisfaction, years of working experience, professional title, position and work environment) and other variables (social support, coping strategy, self‐compassion, professional cognition and psychological training).

    Conclusion

    Oncology nurses were at “moderate” level of compassion satisfaction, burnout and secondary traumatic stress, and 22% of oncology nurses suffered from “high” risk of compassion fatigue. Hospital administrators should develop interventions to address compassion fatigue phenomenon, and enhance the mental health of oncology nurses and nursing care results.

    Relevance to clinical practice

    Oncology unit warrants special attention, and oncology nurses are at high risk for compassion fatigue. However, the reported prevalence rates and oncology nurses with different characteristics vary considerably. The review provides a preliminary framework for nursing administrators to develop interventions to address compassion fatigue phenomenon, and enhance the psychological health of oncology nurses.

    The Risk Factors for the Exacerbation of COVID‐19 Disease: A Case–control Study

    Abstract

    Aims and Objectives

    To investigate the factors associated with the exacerbations of COVID‐19.

    Background

    At present, COVID‐19 is prevalent in the world, seriously endangering the property and life safety of people around the world. Currently, there are many reports on the clinical features, complications and risk factors of death of COVID‐19, but there are few reports on the factors associated with the exacerbation of COVID‐19.

    Design

    Case–control Study.

    Methods

    Patients with COVID‐19 were recruited from four designated hospitals for novel coronavirus pneumonia in Xiangyang City, Hubei Province from January to April 2020. The patients were divided into disease exacerbation group (n = 53) and disease stabilisation group (n = 265) according to the disease progression during hospitalisation. Univariate analysis and multivariate logistic regression were used to identify the factors associated with the exacerbation of COVID‐19. The research was reported according to STROBE statement.

    Results

    Univariate analysis showed there were significant differences in gender, age, hypertension, heart disease, kidney disease, white blood cell count, percentage of neutrophil, percentage of lymphocyte, C‐reactive protein, lactate dehydrogenase, total protein, albumin, creatinine, calcium ion, rate of erythrocyte sedimentation, cough, expectoration, chest tightness, gastrointestinal discomfort and dyspnoea between the two groups. The variables with p < 0.05 in the aforementioned difference analysis were included in binary logistic regression analysis, which showed that age, hypertension history, chest tightness, percentage of neutrophil, percentage of lymphocyte, lactate dehydrogenase and creatinine were independent factors associated with COVID‐19 disease exacerbation.

    Conclusion

    Clinicians may warn the exacerbation of COVID‐19 facing above risk factors and associated characteristics, and adjust the diagnosis and treatment plan to delay the disease progression, reduce complications and mortality and improve the prognosis of patients.

    Relevance to Clinical Practice

    Patients with certain risk factors associated with COVID‐19 diseases exacerbation should be observed and targeted by using effective early interventions.

    Effectiveness of double‐gloving method on prevention of surgical glove perforations and blood contamination: A systematic review and meta‐analysis

    Abstract

    Aims

    To determine the effectiveness of the double‐gloving method on preventing surgical glove perforation and blood contamination compared with single gloving.

    Design

    Systematic review.

    Data sources

    Seven electronic databases were searched including: Embase, CINAHL, OVID, Medline, Pubmed, Web of Science, and Foreign Medical Literature Retrieval Service in March 2020.

    Review method

    Our systematic review and meta‐analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) reporting guideline. Risk of bias of Cochrane Handbook (Version 5.1.0) was applied to evaluate the study quality. Revman 5.3 was used to calculate the effect size of odds ratio (OR) with 95% confidence interval (CI). Meta‐analysis with forest plot and funnel plot was performed to compare the rate of surgical glove perforation and to determine the published bias, respectively. This review has been registered with ID: CRD42020189694 on the web site of PROSPERO.

    Results

    Seven randomized controlled trials regarding the efficacy of double gloving on reducing surgical glove perforation were identified and a total of 7090 gloves were tested. After analyzing the pooled data, we identified that the rate of surgical glove perforation in the double‐gloving group was lower than that of single gloving with statistical significance (OR = 0.75, 95% CI: 0.64–0.89, p < .05). It was statistically significant that surgical glove perforation was lower in the double‐inner gloves as well as matched outer–inner perforated gloves compared with that of single glove (OR = 0.05, 95% CI: 0.03–0.07, p < .05).

    Conclusion

    Findings of this systematic review demonstrate that double gloving could reduce the rate of surgical‐glove perforation. Meanwhile, the risk of being contaminated by a blood‐borne pathogen during surgery could be reduced by wearing double gloves. We strongly suggest that surgical team members when operating should wear double gloves to protect themselves and reduce the risk of occupational blood exposure.

    Impact

    The necessity of double gloving for preventing blood contamination was demonstrated. The rate of surgical glove perforation is statistically significant in double‐gloving group compared to single gloving. Double gloving could reduce the risk of being contaminated during surgery by blood‐borne pathogen. Evidence is provided for surgical team and decision makers that double gloving could reduce occupational exposure.

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